Simple technique of percutaneous ligation of accessory veins for salvage of failing arteriovenous fistulae
Authors:
M. Šercl 1; V. Machačka 1; P. Kočí 2; V. Mellanová 1; L. Endrych 1
Authors‘ workplace:
RDG oddělení, Krajská nemocnice Liberec, a. s., primář: MUDr. L. Endrych
1; Oddělení hemodialýzy, Krajská nemocnice Liberec, a. s., primář: MUDr. M. Ryba
2
Published in:
Rozhl. Chir., 2017, roč. 96, č. 7, s. 296-301.
Category:
Original articles
Overview
Introduction:
Non-maturing arteriovenous fistula is a common problem in hemodialysis units. The main reasons for maturation failure include a poor venous system, vein stenosis, stenosis in an anastomosis, or the presence of collateral veins. Currently, the usual approach to eliminate collateral vein drainage consists in surgical ligation or coil embolization; however, these procedures are time-consuming, logistically demanding and expensive. Alternatively, various types of percutaneous ligation are done. Below follows the description of a technique of image-guided percutaneous ligation of collateral veins and an analysis of our cohort of patients.
Method:
A retrospective study of prospectively enrolled patients with non-maturing arteriovenous fistulae. The criterion of success was defined as successful hemodialysis within 4 weeks after percutaneous ligation.
Results:
During a 2-year period (March 2015 – January 2017) 7 patients underwent 11 ligations of collateral veins. In all patients the arteriovenous shunts matured successfully for hemodialysis within 2 or 3 weeks following the ligation.
Conclusion:
The novel technique is fast, inexpensive and provides a good clinical and cosmetic outcome.
Key words:
arteriovenous fistula – collateral veins – percutaneus ligation
Sources
1. Hemodialysis Adequacy Work G. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006;48 Suppl 1:S2–90.
2. Janoušek L, Baláž P. Hemodialyzační arteriovenózní přístupy. Praha, Grada 2008.
3. Coburn MC, Carney WI, Jr. Comparison of basilic vein and polytetrafluoroethylene for brachial arteriovenous fistula. J Vasc Surg 1994;20:896-902; discussion 903–4.
4. Kudlicka J, Malik J, Tuka V, et al. Arteriovenous grafts: early ultrasonography tells their fortune. Am J Nephrol 2015;41:420–5.
5. Malik J, Tuka V, Chytilova E, et al. Low-flow polytetrafluoroethylene accesses: ultrasound surveillance and preemptive interventions ensure long-term patency. Kidney Blood Press Res 2010;33:181–5.
6. Tuka V, Slavikova M, Krupickova Z, et al. Short-term outcomes of borderline stenoses in vascular accesses with PTFE grafts. Nephrol Dial Transplant 2009;24:3193–7.
7. Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol 2013;24:465–73.
8. Beathard GA, Arnold P, Jackson J, et al. Aggressive treatment of early fistula failure. Kidney Int 2003;64:1487–94.
9. Faiyaz R, Abreo K, Zaman F, et al. Salvage of poorly developed arteriovenous fistulae with percutaneous ligation of accessory veins. Am J Kidney Dis 2002;39:824–7.
10. Miller PE, Tolwani A, Luscy CP, et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999;56:275–80.
11. Mašková J, Komárková J, Kivánek J. Endovascular treatment of central vein stenoses and/or occlusions in hemodialysis patients. Cardiovascular and Interventional Radiology 2003;26:27–30.
12. Haq NU, Althaf MM, Lee T. Accessory vein obliteration for early fistula failure: A myth or reality? Adv Chronic Kidney Dis 2015;22:438–45.
13. Malik J, Kudlicka J, Novakova L, et al. Surveillance of arteriovenous accesses with the use of duplex Doppler ultrasonography. J Vasc Access. 2014;15 Suppl 7:S28–32.
14. Kudlicka J, Kavan J, Tuka V, et al. More precise diagnosis of access stenosis: ultrasonography versus angiography. J Vasc Access 2012;13:310–4.
15. Cui J, Freed R, Liu F, et al. Interrupting rivaling access-flow with nonsurgical image-guided ligation: the “IRANI” procedure. Semin Dial 2015;28:E53–7.
16. Dixon BS. Why don’t fistulas mature? Kidney Int 2006;70:1413–22.
17. Feldman HI, Joffe M, Rosas SE, et al. Predictors of successful arteriovenous fistula maturation. Am J Kidney Dis 2003;42:1000–12.
18. Lacson E, Jr., Lazarus JM, Himmelfarb J, et al. Balancing fistula first with catheters last. Am J Kidney Dis 2007;50:379–95.
19. Beathard GA, Settle SM, Shields MW. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis 1999;33:910–6.
20. Allon M, Lockhart ME, Lilly RZ, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 2001;60:2013–20.
21. Ahmed O, Patel M, Ginsburg M, et al. Effectiveness of collateral vein embolization for salvage of immature native arteriovenous fistulas. J Vasc Interv Radiol 2014;25:1890–4.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2017 Issue 7
Most read in this issue
- Invagination in an adult as a rare cause of acute abdomen – 2 case reports
- Minimally invasive liver resections
- Gallbladder volvulus
- Subclavian steal-carotid recovery phenomenon – “old school” surgical procedure